提高黑人患者的药物续用率和高血压控制率：威斯康星州 TEAM 试验。
Improving refill adherence and hypertension control in black patients: Wisconsin TEAM trial.
出版信息
J Am Pharm Assoc (2003). 2013 Sep-Oct;53(5):520-9. doi: 10.1331/JAPhA.2013.12246.
OBJECTIVE
To assess the effectiveness and sustainability of a 6-month Team Education and Adherence Monitoring (TEAM) intervention for black patients with hypertension in community chain pharmacies.
DESIGN
Cluster randomized trial.
SETTING
28 chain pharmacies (14 TEAM and 14 control) in five Wisconsin cities from December 2006 to February 2009.
PARTICIPANTS
576 black patients with hypertension.
INTERVENTION
Trained pharmacist-technician teams implemented a 6-month intervention using scheduled visits, Brief Medication Questionnaires (BMQs), and novel toolkits for facilitating medication adherence and pharmacist feedback to patients and physicians. Control participants received patient information only.
MAIN OUTCOME MEASURES
Refill adherence (≥80% days covered) and changes in systolic blood pressure (SBP), diastolic blood pressure, and blood pressure control using blinded assessments at 6 and 12 months.
RESULTS
At baseline, all patients had blood pressure of 140/90 mm Hg or more. Of those eligible, 79% activated the intervention (mean 4.25 visits). Compared with control participants at 6 months, TEAM participants achieved greater improvements in refill adherence (60% vs. 34%, P < 0.001), SBP (-12.62 vs. -5.31 mm Hg, P < 0.001), and blood pressure control (50% vs. 36%, P = 0.01). Six months after intervention discontinuation, TEAM participants showed sustained improvements in refill adherence ( P < 0.001) and SBP ( P = 0.004), though the difference in blood pressure control was not significant ( P < 0.05) compared with control participants. Analysis of intervention fidelity showed that patients who received the full intervention during months 1 through 6 achieved significantly greater 6- and 12-month improvements in refill adherence and blood pressure control compared with control participants.
CONCLUSION
A team-based intervention involving community chain pharmacists, pharmacy technicians, and novel toolkits led to significant and sustained improvements in refill adherence and SBP in black patients with hypertension.
目的
评估针对社区连锁药店中的黑人高血压患者实施为期 6 个月的团队教育和依从性监测（TEAM）干预的效果和可持续性。
设计
整群随机试验。
地点
2006 年 12 月至 2009 年 2 月期间，威斯康星州五个城市的 28 家连锁药店（14 家 TEAM 和 14 家对照组）。
参与者
576 名黑人高血压患者。
干预措施
经过培训的药剂师-技术员团队使用定期就诊、简短用药问卷（BMQs）以及促进药物依从性和药剂师向患者和医生提供反馈的新型工具包实施了为期 6 个月的干预措施。对照组仅接受患者信息。
主要观察指标
在 6 个月和 12 个月时使用盲法评估，以评估药物补充的依从性（≥80%的天数被覆盖）和收缩压（SBP）、舒张压和血压控制的变化。
结果
在基线时，所有患者的血压均为 140/90mmHg 或更高。在符合条件的患者中，有 79%（平均 4.25 次就诊）激活了干预措施。与 6 个月时的对照组相比，TEAM 组在药物补充的依从性（60% vs. 34%，P<0.001）、SBP（-12.62 vs. -5.31mmHg，P<0.001）和血压控制（50% vs. 36%，P=0.01）方面取得了更大的改善。在干预停止后 6 个月，TEAM 组在药物补充的依从性（P<0.001）和 SBP（P=0.004）方面表现出持续的改善，尽管与对照组相比，血压控制的差异无统计学意义（P<0.05）。对干预措施一致性的分析表明，在 1 至 6 个月期间接受完整干预措施的患者，在药物补充的依从性和血压控制方面，与对照组相比，在 6 个月和 12 个月时取得了显著更大的改善。
结论
一项涉及社区连锁药剂师、药剂技术员和新型工具包的团队干预措施，使黑人高血压患者的药物补充依从性和 SBP 显著且持续改善。
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